Panda Bear just diagnosed

[wendyweneki]

Just found this group and joined this evening. Just found out today that our Panda Bear has Cushings. Kind of overwhelmed and just praying that everything is going to be OK.

She was diagnosed through a clinic that we don't normally go through. Their pharmacy isn't open today, so they said it was OK for us to wait to see our regular vet on Tuesday and we can start the medicine then.

So happy to see this group and know I have resources and support through everyone on here. It's kind of overwhelming with all the different threads. I hope I can figure out how to work this entire site.

Thank you for being here.... I greatly appreciate it.

Mind is still spinning. Panda Bear is only 8 years old.

[mytil]

Welcome to you both.

I have taken the liberty of starting a new thread for you and Panda Bear from your post in our Checking in section.

When you get the chance, post the results of the Cushing's diagnosis here. Cushing's is difficult to diagnose as many of the symptoms are also symptoms of other conditions and these have to be ruled out (i.e. diabetes, thyroid deficiencies, liver problems).

Is your Panda Bear on any other medications for any other conditions at this point?

Terry

[molly muffin]

Welcome to you and Panda Bear.

What symptoms made them decide to check for cushings? Do you have the results of the test for cushings and also any irregular high / low on blood test with range you could post? (this helps us to give you better feed back)

Which medication are they prescribing? Vetroyl or lysodren? If vetroyl (trilostane) the starting dose should be no more than 1mg/1lb. (this has recently been revised by the manufacturer).

We're very happy that you found us too. :)

[Sadielove]

Wendy I am so sorry to hear you are going having to go through this as well I can tell you I think I have read every thread and Google and Bing link there is about cushings. I am going to put my baby on a high protein low fat diet to help her. I am wondering if she should be on an omega 3 and probiotic from others things I have read.

[wendyweneki]

SadieLove - Is a high protien, low fat diet help Cushings? Thank you for your post, I appreciate that.

[wendyweneki]

Molly Muffin,

I hope I am responding to the posts correctly. This may take me a minute to figure out. We have appt tomorrow at 4:45 to sit down with Dr.

We don't have any of the results - didn't even think to ask for the numbers. Actually, I just realized, because we got the info over the telephone.

She has had constant urinary infections over the past year. This last time, they said they wanted to do an utlrasound. When they did it, they said they found a 'coating' on all of her bladder and kidneys and this is something that cushing's causes. So they did the test and they told us she has cushing's.

Problem is that the coating on her bladder and kidney's still could be cancer. We have to wait to see if it goes away with the cushing's medication and then go from there.

She has not started the medicine yet, we start it tomorrow. I will have a lot more info after the Dr. appt.

So thankful for this group!!! You don't even know how lost and confused we are. I am sure I will be coming here for lot of help and advice.

[wendyweneki]

I am taking off work today so I can sit and think about what kind of questions I should be asking the Vet today.

Do any of you have any suggestions of questions I should be asking? Or that I will regret not asking after I leave the Dr.'s?

We should be getting the medications today. They are charging $81.00 for 30 pills. 10mg. Do any of you have suggestions of other places? I saw Pet360 has them for $51 (?). Is this a safe place to order them from. Any other suggestions.

I found the following statement on a website about k9 Cushings which is of concern:

"While Trilostane does work regardless if the HAC is PDH or ADH, it is more effective if the disease is PDH."

Which gives me my first two questions......

1. Do we know if this is PDH or ADH? If not, is there anyway of knowing?
What is PDH and ADH?
2. How much are the blood tests that she will need to get and how often does she need the blood tests?

Thank you for any and all responses. I love the encouragement, just knowing we are not in this alone.

Peace, Love and Lots of Laughter,

[wendyweneki]

Has anyone else heard of a 'coating' that is all over the bladder and kidneys found during an ultrsound?

Is this common with cushings?

They said that if it doesn't clear up with the cushings medication - then they are going to go in with a camera and it might be cancer.

[Harley PoMMom]

I've not heard of a "coating" on the bladder and kidneys, could you ask the vet to elaborate on that for me?

ADH is the abbreviation for adrenal dependent hypercorticism which means that the Cushing's is caused from a tumor on one or both adrenal glands.

PDH stands for pituitary dependent hypercorticism, and this type of Cushing's is caused by a tumor on the pituitary gland, the majority of dogs, around 85%, have PDH.

If a dog does have ADH and is a good candidate an adrenalectomy can be a cure however this is a very serious and very expensive surgery.

The low dose dexamethasone suppression test (LDDS) is the gold standard test used to diagnose Cushing's and it has the potential to differentiate between ADH and PDH. If the LDDS test is inconclusive than an ultrasound can be done and if both of the adrenal glands are visualized this may point to a diagnosis of ADH or PDH.

The blood test needed to monitor treatment is the ACTH stimulation, and unfortunately it is costly because of the stimulating agent. Most vets use Cortrosyn as the stimulating agent and we call it liquid gold because that's what drives the ridiculous price. Those ACTH stim tests are very expensive but very necessary. One question I would ask the vet is what stimulating agent they use. And depending on how much Panda Bear weighs there is a cost saving tip on saving money on those stim tests. You see, the vial of Cortrosyn is .25mg and instructions say to use entire vial but not all dogs need the entire vial. There have been studies done that show using just 5mcg per kg is all that's needed. Some vets are not aware of this so we always provide the url to Dr. Mark Peterson's blog which instructs vets on how to dilute and store Cortrosyn for future use.http://www.k9cushings.com/forum/showpost.php?p=69247&postcount=61 so I would ask the vet if s/he is doing this.

A monitoring ACTH test is recommended to be done 10-14 days after treatment begins. When any dosage adjustments are made an ACTH stimulation test should be performed within 2 weeks. Once an optimum dose of Vetoryl has been reached, the dog should be retested at 30 days, 90 days and every 3 months thereafter and Dechra also recommends having a chemistry blood panel done to check the electrolytes, liver and kidney markers...etc.

It would help us to provide you with more meaningful feedback if you would get copies of all the tests that were done Panda Bear and post those results here, we are especially interested in the results of the test/s that were performed to diagnose the Cushing's. What symptoms does Panda Bear display that led the vet to test for Cushing's in the first place? Is she taking any other supplements/herbs/medications? Is her urine diluted and if so have they performed an urine culture and sensitivity test to check for any bacteria in her urine?

Dechra now recommends Vetoryl to be started at 1mg per pound of a dog's weight, I would ask the vet if s/he is aware of this, if not here's a link to that info:http://www.vettimes.co.uk/news/new-lower-starting-dose-for-vetoryl/ Vetoryl has to be given with food and those monitoring ACTH tests have to be performed 4-6 hours post pill, ask if they follow this protocol.

This is all I can think of right now, if anything else comes to my mind I'll get back to you. ;)

Hugs, Lori

Remembered something else: Having the Trilostane (active ingredient in Vetoryl) compounded saves money too, diamondback pharmacy is one that members use.

[wendyweneki]

There's pages and pages and pages of stuff. I think this is the test reading. Does this make sense to you? Panda Bear started her meds last night. I stayed home from work today just to watch her. I don't see any difference in her behavior. Just as lazy as always. :) :)

Panda Bear presents today for a Low Dose Dex Suppression test.

Diagnostics Performed:
LDDS pre 10.7, 4hr 1.5, 8hr 4.9
Comments:
LDDS test is consistent with PDH.
Recommendations:
Start Trilostane 10mg BID
Recheck ACTH stim in 2 weeks

[Harley PoMMom]

There's pages and pages and pages of stuff. I think this is the test reading. Does this make sense to you? Panda Bear started her meds last night. I stayed home from work today just to watch her. I don't see any difference in her behavior. Just as lazy as always. :) :)

How much does she weigh? The recommended starting Vetoryl dose is 1 mg per pound of a dog's weight, which I'm sure you probably already know but I just wanted to make sure of this ;):)


Panda Bear presents today for a Low Dose Dex Suppression test.

Diagnostics Performed:
LDDS pre 10.7, 4hr 1.5, 8hr 4.9
Comments:
LDDS test is consistent with PDH.
Recommendations:
Start Trilostane 10mg BID
Recheck ACTH stim in 2 weeks

Yep, looks like Low Dose Dex Suppression test and it does indicate the pituitary type (PDH).

[wendyweneki]

She's 20 pounds. Twice a day - 10 mg, sounds about right. I've been following all the threads, trying to keep up on all advice/suggestions.

She started pills last night. I can't tell if she is tolerating it or not. I guess that's she not throwing up or going into seizures is a good sign.

[Harley PoMMom]

Some adverse signs are loss of appetite, diarrhea, vomiting, lethargic, or she is just not acting herself, if you see any one of these symptoms withholding the Vetoryl is the right thing to do.

Panda Bear's Vetoryl dose is spot on and I'm sure she'll do fine.

[molly muffin]

Dosage seems spot on for weight and the ldds test result is consistent with pituitary Cushing's which is the type most dogs have. It's usually a very small tumor on the pituitary. The tumor even though normally very very small is telling the adrenals to make cortisol at an increased rate. The vetroyl interrupts the signal telling the adrenal glands to make more cortisol.

[wendyweneki]

Panda Bear is not pooping. My thought is that since her diagnosis, we have been giving her extra treats and then giving her more treats so she can take the pills on a full tummy. She is a very picky eater to begin with and in the past few days we have loaded her with treats and she hasn't eaten any of her regular food.

Sometimes she seems just fine - other times I wonder if she is not fine. She spent most of yesterday underneath the end table. She does that when she doesn't feel well - but then again, it was kind of warm yesterday and she does that when she is hot also.

It's so hard to tell with her. There's no throwing up - I guess that's a good sign. Can these pills cause constipation? Or is it probably all the treats and no real food?

I am making her chicken now so she can take her morning meds without treats this time.

[Brooke]

Hi Wendy, thought I would pop in on your thread to check on Panda Bear. I wanted to mention that it is important to give the vetoryl with a full breakfast - not just a treat - apparently that helps the medicine absorb properly and is also less likely to upset their tummy.

Also, If she's not used to getting that many treats - that definitely can cause changes in their pooping habits and might be the cause of the constipation. Someone gave me this advice - when starting the vetoryl, keep your pet on their regular diet as much as possible so you will know the diet is not a factor if they have tummy troubles like vomiting, diarrhea etc. Any little change in diet will throw my Bella off and can constipate her or give her diarrhea. So best to keep giving Panda Bear her regular food.

I give bella a full breakfast, and when she finishes, I immediately give her the vetoryl hidden in some peanut butter.

Keep us posted, I'll be checking on you! :)

[wendyweneki]

Thank you Brooke. Greatly appreciate your concern. :) :) Learning as we go. :) :)

[Harley PoMMom]

Brooke is absolutely correct, you don't want to change or deviate from Panda Bear's regular diet, because as Brooke has mentioned, if Panda Bear would start acting ill it would be too difficult to rule out the change in the diet as the culprit for her acting unwell.

Is she still constipated?

Hugs, Lori

[wendyweneki]

Panda took a poopie but she still doesn't seem to be herself. She seemed to be whining in her sleep earlier. She also seems very depressed. I'm starting to not like this medicine.

So far the only real issue with her is the frequent UTI's. I'm starting to wonder about not treating her for cushing's - if this is the way she is going to be acting.

I read on another site where a lady changed her dogs diet and she improved. She chose not to treat the cushing's and her dog is still doing fine.

Has anyone chose that route? How did it work out? What dietary changes/improvements could we make? Does it take a while for the dog to get used to the medicine? If yes, how long usually?

[Harley PoMMom]

Some dogs may be more sensitive to Trilostane than others. I wonder if the reason for her whining is because she is still constipated and needs a suppository to help things along.

Holistic/homeopathic treatment may help with the symptoms but unfortunately they do not address the main problem that a dog with Cushing's has, which is the elevated cortisol.

[wendyweneki]

We took her to our 'regular' vet today for the first time. The other lady we took her to worked in the same office.

I love our vet... she is so awesome. So we did a lot of online research. One of the things that was mentioned is that Melotonin can reduce the cortizone. When Latasha (my daughter) brought this up to the vet - at first she said that was just a rumor. Then she got the medical book out and said "WOW - I was wrong. Melotonin can help recude the cortizone.

Because of the way Panda is looking - and all of our concerns, Dr. has OK'd for us to give her 10mg (one time a day) and a melatonin. (Dr. checked to make sure they can be given together.)

We got a lot of good info from this Vet - She will be going to get another ultrasound next week to look again at the bladder to see if it is cleared up - or if we need to look further into it maybe being cancer. :( :( Please keep Panda in your prayers.

[wendyweneki]

Love this video....

https://www.youtube.com/watch?v=0vByprTTj1c&feature=youtu.be

[molly muffin]

Oh goodness. I do hope that the bladder coating isn't anything serious like cancer.
How is she doing now on the medication? Is she pooping alright now?
yes melatonin can help to lower, it just usually isn't enough by itself to lower cortisol enough in cushing dogs.

Hoping Panda Bear is feeling a bit better.

[wendyweneki]

Panda is feeling much better since reducing the pill to once a day (10mg). I know that isn't much - but maybe she needs a little time to get used to it. She slept through the night, has the sparkle back in her eyes and isn't trying to eat grass anymore. And she is no longer constipated.

Thank you so much for checking in on her. I greatly appreciate that. We take her in on Friday for the urine analysis - and ultrasound to look at the bladder and make sure the 'crystalization' is gone. I hope and pray so.

[molly muffin]

Oh good to hear that she is feeling better and more herself.

Fingers toes paws crossed that Friday is good news.

[wendyweneki]

NEED ADVICE/INPUT

Ok, so Panda has been acting GREAT since we started only giving her 10 mg a day. The only thing is that they only make 10mg tablets, so we give it to her once a day. The other vet today said that it is not meant to be given once a day - it has to be given twice a day, so she needs to be taking 5mg, 2 times a day.

Do any of you give your dog the pill one time a day and have symptoms managed?

UTI is all cleared up now and her bladder looks good.

[Help4Bailey]

Hi Wendy,

I am new to the Cushing forum and new to all that is Cushing's since our girl, Bailey was diagnosed in late February.

Bailey is on 10mg of Trilostane once a day and her symptoms are controlled for now. She was previously on a higher dose of 30mg which was way too strong for her and had to be placed on 10mg even though she weighs 23 lbs now.

I have read other posts from several of the more knowledgeable people regarding Cushings and twice daily dosing. From what I have read, it is quite common or necessary for dogs that are diabetic with Cushing's to have twice daily dosing. It is my understanding that if 10mg is the dosage then a diabetic dog with Cushing's would be given 5mg twice a day. I have seen on websites that Vetoryl/Trilostane is available in 5mg tablets.

I am sure that others on this forum can provide you with additional information. I am glad to hear that your pup is doing well with the 10mg dose.

Lynette

[Help4Bailey]

I am taking off work today so I can sit and think about what kind of questions I should be asking the Vet today.

Do any of you have any suggestions of questions I should be asking? Or that I will regret not asking after I leave the Dr.'s?

We should be getting the medications today. They are charging $81.00 for 30 pills. 10mg. Do any of you have suggestions of other places? I saw Pet360 has them for $51 (?). Is this a safe place to order them from. Any other suggestions.

I found the following statement on a website about k9 Cushings which is of concern:

"While Trilostane does work regardless if the HAC is PDH or ADH, it is more effective if the disease is PDH."

Which gives me my first two questions......

1. Do we know if this is PDH or ADH? If not, is there anyway of knowing?
What is PDH and ADH?
2. How much are the blood tests that she will need to get and how often does she need the blood tests?

Thank you for any and all responses. I love the encouragement, just knowing we are not in this alone.

Peace, Love and Lots of Laughter,

Hi Wendy,

I used a website called VetRxDirect which was on a list of Vet-VIPPS accreditation from the National Association Board of Pharmacy. I also looked them up on Better Business Bureau and they were rated A+. Comments from people who purchased from VetRxDirect were also positive so I gave them a try. I had to send in my original prescription since my vet would not fax nor will not talk to any online pharmacy. I mailed my prescription on April 8 and received the 10mg/Vetoryl/Trilostane today, April 15. Everything went very smoothly. I did speak with them prior to sending in my prescription knowing that my vet would not talk to them and to make sure I had the correct address etc. I believe the Pet360 Pharmacy website is also on the list of VIPPS.
Hope this information might be of assistance to you.
Lynette

[labblab]

NEED ADVICE/INPUT

Ok, so Panda has been acting GREAT since we started only giving her 10 mg a day. The only thing is that they only make 10mg tablets, so we give it to her once a day. The other vet today said that it is not meant to be given once a day - it has to be given twice a day, so she needs to be taking 5mg, 2 times a day.

Do any of you give your dog the pill one time a day and have symptoms managed?

UTI is all cleared up now and her bladder looks good.
That is wonderful that Panda is doing so well. Lynette has already given you some great information, and as she says, there are specific reasons why diabetic dogs who require insulin are better treated with twice daily dosing. But otherwise, your new vet is incorrect in saying that trilostane is "meant" to be given twice daily and must be split in order to be effective. In fact, the manufacturer of Vetoryl (Dechra) recommends that new patients always begin with one daily dose in the morning, and only switch to twice daily dosing in the event that cortisol levels are within therapeutic levels 4-6 hours after dosing but symptoms are rebounding later in the day.

It is true that some clinicians and researchers prefer twice daily dosing when it is feasible, with the theory being that less total drug may be needed and symptoms may be better controlled if the dog is consistently getting a dose every 12 hours. However, we have been told that there is a flip side to that, in that dogs who are dosed twice daily may be at greater risk of having their cortisol drop too low.

The bottom line is that we have many dogs here who are successfully dosed only once daily in the morning. So if Panda continues to do well on that protocol, I'd personally not see a big reason to change. However, if you do wish to shift and the daily total of 10 mg. seems ideal, then Lynette is correct that 5 mg. Vetoryl capsules are now available for sale.

Here's an important question for you, however. Has Panda been scheduled yet for a followup monitoring ACTH test within the next few weeks? It is very important to find out how the 10 mg. dose is affecting her actual cortisol level. From what I can tell, she's now been taking the med for about a week. Dechra prefers that the first monitoring ACTH be performed after two weeks. As long as a dog is outwardly doing well, some clinicians are opting to wait for 30 days. But you definitely should wait no longer than that to test.

Marianne

[wendyweneki]

Lynette and Marianne,

Thank you for your responses. I feel so much better after reading them. I'm glad to hear that Baily is stable and doing well.

We will be getting her tested in another week. Since we started her on the 2 pills a day and then went down to 1 pill a day last Friday, so Dr. said to wait the two weeks from the day that she started the one per day.

Panda has been doing AWESOME. Even acting like a puppy again. Except for last night, she was up and down the entire night. I'm going to keep my eye on her - but I have been loving seeing her so happy and not in discomfort and pain. I know some of that is the cleared up UTI - but I think some of it is the cushing's being stabilized.

Again, thank you to both of you for the info. You have both made me feel so much better.

Wendy

[Sadielove]

Hi Wendy. I am so glad panda is doing Better. We started Sadie one a once daily pill. She seems fine so far. We are on day four. We will keep praying for panda and Sadie to continue to improve. Keep in touch.

[LauraA]

Hi Wendy, my Cush girl has been on one pill a day for a good 2 1/2 years with no problems (touch wood, hope I haven't jinxed myself!). Some dogs do fine on once a day and others seem to suffer a rebound in the afternoon of symptoms and do better on a split dose. So much tweaking and playing around with meds and Stim tests at the start but it does ease up :)

[molly muffin]

I'm another once a day dog mom. Molly gets her trilostane in the morning with breakfast.

[wendyweneki]

When you guys do the retest - if the tests has to be done on an empty stomach but you have to give meds with food. How do your vets do this?

[LauraA]

If it is the ACTH Stim test then it shouldn't be done on an empty stomach, the meds should be taken as usual with a meal and the test should be done withing 3-4 hours after taking the pill.

[wendyweneki]

Why does this vet not know this. She kept going back and fourth and back and fourth and back and fourth saying she could eat and then saying that she shouldn't eat. :( :( :( This is very scary. Thank you for replying so fast.... I appreciate that GREATLY. I think we are going to feed her as usual and just let them know that when we get there.

This forum ROCKS!!!!!! Thank God I have you guys. First test tomorrow to see how her blood work is. Cross your fingers and say a little prayer. She does act a whole lot better (like a puppy) at times - but then there's those days that she is just her lazy self.

[LauraA]

We will have fingers and paws crossed for some good results tomorrow :) It took many months for my girls panting to subside, luckily her incontinence cleared pretty fast once we started the Vetoryl.

[lulusmom]

I've provided the url to Dechra's technical brochure below that pet owners and vets can use to educate themselves on the diagnosis, treatment and monitoring of treatment. You will see numerous references to administering the capsule with a meal but you will want to pay particular attention to "The Treatment and Monitoring Hyperadrenocorticism" flow chart which clearly states "Ensure morning capsule was given with food". I highly recommend that you print out this chart, or the whole brochure, for your vet so that she understands that a fasted blood sample will invalidate the results of the acth stimulation test. Helping educate her will benefit, not only your dog and your wallet, but any other cushdogs she may be treating now or in the future.

Glynda

http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf

[wendyweneki]

GOOD NEWS - GOOD NEWS - GOOD NEWS.

So remember when Panda started the meds at 20mg. (10 in the morning and 10 in the evening). She wasn't doing too well. We talked to our REGULAR vet and she said to go ahead and take her down to 10mg and give her melatonin.

The other vet said that wouldn't help at all..... but WAH-LAH...

Panda's test came back and they show that she is at a good level. I don't really know if the melatonin is really helping or not - but we gave it to her with her pill the morning of the testing so we are going to continue with it.

She does seem to be doing much better. She does act like a puppy again, as others have said. Today she played with Scruffy for an entire half an hour without stopping. I was shocked.

So just so you all know - she weighs 20 pounds and is doing well on only 10mg of the meds and a melatonin (3mg). Thank you all for your love, support and advice. I sometimes trust you more than I trust some of these vets.

[DoxieMama]

Yay Panda! So glad to hear this good news.

[Help4Bailey]

GOOD NEWS - GOOD NEWS - GOOD NEWS.

So remember when Panda started the meds at 20mg. (10 in the morning and 10 in the evening). She wasn't doing too well. We talked to our REGULAR vet and she said to go ahead and take her down to 10mg and give her melatonin.

The other vet said that wouldn't help at all..... but WAH-LAH...

Panda's test came back and they show that she is at a good level. I don't really know if the melatonin is really helping or not - but we gave it to her with her pill the morning of the testing so we are going to continue with it.

She does seem to be doing much better. She does act like a puppy again, as others have said. Today she played with Scruffy for an entire half an hour without stopping. I was shocked.

So just so you all know - she weighs 20 pounds and is doing well on only 10mg of the meds and a melatonin (3mg). Thank you all for your love, support and advice. I sometimes trust you more than I trust some of these vets.


Glad to hear that Panda is doing well on 10mg! May I ask the reason for the Melatonin? Is it to help with sleep? Our girl is also on 10mg of Trilostane but she sleeps well at night without getting up to pee. Lynette

[wendyweneki]

This forum/threads kind of confuse me. It's me and my 'web/community ignorance'. Just wanted to send my love to everyone dealing with a dog with Cushing's. This can be really rough. Panda Bear has had her ups and downs. Other emergencies have arisen, not sure if from the cushing's or not. Thank God Care Credit upped our limit and we were able to get her surgery. Right now she is doing good. She is mad that we don't give her anymore 'people food'. Doctor says she can't have any people food because of the kidney stones. Do you know of any good treats that are OK for a dog on CD Hill food?
I hope you all are doing well - I hope your dogs are happy.
Peace, Love and Lots of Laughter,

[Harley PoMMom]

I have merged your latest post with your original thread so as to keep all of Panda Bear's history in one place. Sometimes it's difficult to find our threads when they aren't showing on the first few pages so I will be sending you a message with a link to your thread so that you can bookmark it or just keep it in your inbox for ready reference. ;)

I am sorry to read that Panda Bear had to have surgery. Would you mind telling us what happened and what surgery was done? And I hear about Care Credit, I know it helped me immensely with vet bills.

The two common stone formations are struvite and oxalate. Were Panda Bear's stones sent out to be analyzed? One of my boys had oxalate stones and he had to have surgery, twice, to remove them. I have a booklet, somewhere :o, that does contain recipes for dog treats, I will see if I can find it and get back to you.

Hugs, Lori